Alopecia: Small And Bald

16. May 2017

Share article

Small men carry an increased risk of going bald early. This is shown by a study in which human geneticists studied the genomes of 20,000 men. Their data also shows that premature hair loss is associated with various diseases.

Strong and shiny it should be – and fully natural. A luxuriant head of hair on the head is considered the ideal of attractiveness. If one’s hair, however, starts falling out, this often deeply scratches the self-confidence of the person concerned. It is quite normal to lose hair. As a rule about 100 are lost per day; in spring and autumn, as with animals which shed their hair, sometimes more. And stress can also lead to us- having less hair. Basically, however, the losses are so small that they are compensated by regrowth and are not even visible on the head at all. The matter however becomes significant if hair falls out in clumps or handfuls. If men at 30 years of age already show a deep receding hairline on the head, there is probably a hereditary cause of hair loss behind it: androgenetic alopecia.

The hair roots react with what is a probably genetically determined hypersensitivity to a degradation product of the male sex hormone testosterone: dihydrotestosterone (DHT). In addition, the hair roots possibly retain a lot of the enzyme 5-alpha reductase, which ensures that even more DHT is produced. DHT however causes the hair follicles to shrink. Instead of strong hair, what grows are measly strands of hair emerging from atrophied follicles, which sometimes fall out before they even really peep out from the skin. As a result: a bald patch, a bare crown, a shiny dome. About 70 percent of older men are familiar with the problem.

Do small men become bald more often?

An actual study comes to the conclusion that light-skinned and small men lose their hair more often. Stefanie Heilmann-Heimbach, human geneticist from the University of Bonn (Germany), and her colleagues in carrying out the biggest gene study on this subject studied the genomes of more than 20,000 men from seven countries on the risk factors for premature hair loss. “We were able to identify some 63 changes in the human genome which increase the risk of premature hair loss”, explains Stefanie Heilmann-Heimbach.

According to the researchers’ data, however, some gene variants affect not only hair growth. Certain changes also promote an earlier onset of puberty and the risk of certain cancers, such as prostate cancer. In addition, the researchers found correlations to increased bone density, light skin and a smaller body size. “Men with premature hair loss need not necessarily be concerned though”, replies Mark Nöthen, director of the Institute of Human Genetics, University of Bonn. “The risks are increased only slightly. “It is, however, exciting to see that hair loss is by no means an isolated feature, but has a diversity of relationships with other characteristics”.

Such insights into the genetic causes of hair loss are important for science, the medical treatment options for those affected have however not improved for the time being. The demand here is huge. There are indeed already countless remedies that promise help. Nonetheless only few hold what they promise. Researchers have not been able to demonstrate a visible effect from either caffeine shampoos nor for other tinctures available from the pharmacy. According to treatment guidelines for the treatment of androgenetic hair loss, only two active agents are worth considering: minoxidil and finasteride. The hair-promoting effect of minoxidil was discovered by physicians somewhat by chance. In actuality, the substance was supposed to correct the blood pressure of patients. However for some the treatment produced more hair. Today minoxidil, which like caffeine tinctures is massaged into the scalp, is openly available from pharmacies as a remedy for hair loss. For about three out of ten affected men, this treatment can lead to improvements. Nevertheless one can cannot really declare it to be successful treatment, usually only a minimal amount of fluff grows.

Side effect: sexual impotency

Finasteride in contrast is available only by prescription and only to men. The tablets prevent testosterone from being converted to the hair-damaging DHT. After six to twelve months there is an evident improvement in hair growth for about four out of ten men. However, in exchange for having a beautiful head of hair, some men have to take into account potential drop in sexual potency. According to one recent study, erection problems could even go on for months or years after discontinuation of the drug.

In addition: anyone who already has a smooth shiny dome can grease it in as much as he wants, yet he will not get his hair back. Only when the hair is just beginning to thin out can the hair follicles sometimes be stimulated again.

Another option is hair transplantation. This is because when androgenically conditioned hair loss occurs, not all the hair falls out in every case. There often remains a fringe of hair at the back. If some of these hair roots are transplanted to those areas becoming sparse, the patient has a good chance that these roots can also sprout hair at their new location.

The dermatologist, after applying a local anaesthetic, removes a narrow strip of skin from the back of the head. He then works single hair roots or small hair root groups out of the hair strips and puts them back onto the scalp in the desired location. The procedure is generally performed on an outpatient basis. It can however take several months before there is a result to see. There is also no guarantee of success. Sometimes scars arise, the wound possibly gets inflamed or the transplanted hair roots are repelled.

First comes the search for causes

Before men have themselves treated or arrange a date for surgery, they should be examined thoroughly. This is because androgenetic alopecia is not the only reason for dwindling hair. Circular hair loss all starts with one or more round bald patches. There may possibly be a dysregulation of the immune system behind it.

Diffuse hair loss, on the other hand, can be caused by a thyroid disease, hormonal changes or by a radical diet and its associated nutrient deficiency. And finally, various diseases can make hair fall out, lupus for instance, fungal infections or psoriasis. If your hair is falling out, you should first of all clarify what sort of hair loss you are suffering from at all.